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Supportive Care in Cancer

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01-03-2008 | Supportive Care International

Barriers to referral to inpatient palliative care units in Japan: a qualitative survey with content analysis

Authors: Mitsunori Miyashita, Kei Hirai, Tatsuya Morita, Makiko Sanjo, Yosuke Uchitomi

Published in: Supportive Care in Cancer | Issue 3/2008

Abstract

Objectives

We investigated the barriers to referral to inpatient palliative care units (PCUs) through a qualitative study across various sources of information, including terminal cancer patients, their families, physicians, and nurses.

Materials and methods

There were 63 participants, including 13 advanced cancer patients, 10 family members, 20 physicians, and 20 nurses in palliative care and acute care cancer settings from five regional cancer institutes in Japan. Semi-structured interviews were conducted regarding barriers to referral to PCU, and data were analyzed by content analysis method.

Results

A total of 21 barriers were identified by content analysis. The leading barriers were (1) a negative image of PCUs by patients and families (n = 39), (2) delay of termination of anti-cancer treatment by physicians in the general wards (n = 24), (3) unwillingness to end anti-cancer treatment and denial of the fatal nature of the disease by patients and families (n = 22), (4) patient’s wish to receive care from familiar physicians and nurses (n = 20), and (5) insufficient knowledge of PCUs by medical staff in general wards (n = 17).

Conclusions

To correct these unfavorable images and misconceptions of PCUs, it is important to eliminate the negative image of PCUs from the general population, patients, families, and medical staffs. In addition, early introduction of palliative care options to patients and communication skills training regarding breaking bad news are relevant issues for a smooth transition from anti-cancer treatment to palliative care.

Ahmed N, Bestall JC, Ahmedzai SH, Payne SA, Clark D, Noble B (2004) Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals. Palliat Med 18(6):525–542PubMedCrossRef

Baile WF, Lenzi R, Parker PA, Buckman R, Cohen L (2002) Oncologists’ attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol 20(8):2189–2196PubMedCrossRef

Brickner L, Scannell K, Marquet S, Ackerson L (2004) Barriers to hospice care and referrals: survey of physicians’ knowledge, attitudes, and perceptions in a health maintenance organization. J Palliat Med 7(3):411–418PubMedCrossRef

Casarett DJ, Marenberg ME, Karlawish JH (2001) Predictors of withdrawal from hospice. J Palliat Med 4(4):491–497PubMedCrossRef

Feeg VD, Elebiary H (2005) Exploratory study on end-of-life issues: barriers to palliative care and advance directives. Am J Hospice Palliat Care 22(2):119–124CrossRef

Friedman BT, Harwood MK, Shields M (2002) Barriers and enablers to hospice referrals: an expert overview. J Palliat Med 5(1):73–84PubMedCrossRef

Fukui S, Kawagoe H, Masako S, Noriko N, Hiroko N, Toshie M (2003) Determinants of the place of death among terminally ill cancer patients under home hospice care in Japan. Palliat Med 17(5):445–453PubMedCrossRef

Gattellari M, Voigt KJ, Butow PN, Tattersall MHN (2002) When the treatment goal is not cure: are cancer patients equipped to make informed decisions? J Clin Oncol 20(2):503–513PubMedCrossRef

Ida E, Miyachi M, Uemura M, Osakama M, Tajitsu T (2002) Current status of hospice cancer deaths both in-unit and at home (1995–2000), and prospects of home care services in Japan. Palliat Med 16(3):179–184PubMedCrossRef

10.

Johnson CB, Slaninka SC (1999) Barriers to accessing hospice services before a late terminal stage. Death Stud 23(3):225–238PubMedCrossRef

11.

Krippendorff K (1980) Content analysis: an introduction to its methodology. Sage, Beverly Hills

12.

Matsuyama R, Reddy S, Smith TJ (2006) Why do patients choose chemotherapy near the end of life? A review of the perspective of those facing death from cancer. J Clin Oncol 24(21):3490–3496PubMedCrossRef

13.

McNeilly DP, Hillary K (1997) The hospice decision: psychosocial facilitators and barriers. Omega J Death Dying 35(2):193–217CrossRef

14.

Meier DE, Morrison RS, Cassel CK (1997) Improving palliative care. Ann Intern Med 127(3):225–230PubMed

15.

Miyashita M, Sanjo M, Morita T et al (2007) Barriers to providing palliative care and priorities for future actions to advance palliative care in Japan. A nationwide expert opinion survey. J Palliat Med (in press)

16.

Morita T, Akechi T, Ikenaga M et al (2004) Communication about the ending of anticancer treatment and transition to palliative care. Ann Oncol 15(10):1551–1557PubMedCrossRef

17.

Morita T, Akechi T, Ikenaga M et al (2005) Late referrals to specialized palliative care service in Japan. J Clin Oncol 23(12):2637–2644PubMedCrossRef

18.

Morita T, Miyashita M, Shibagaki M et al (2006) Knowledge and beliefs about end-of-life care and the effects of specialized palliative care: a population-based survey in Japan. J Pain Symptom Manage 31(4):306–316PubMedCrossRef

19.

Ogle KS, Mavis B, Wyatt GK (2002) Physicians and hospice care: attitudes, knowledge, and referrals. J Palliat Med 5(1):85–92PubMedCrossRef

20.

Parker PA, Baile WF, de Moor C, Lenzi R, Kudelka AP, Cohen L (2001) Breaking bad news about cancer: patients’ preferences for communication. J Clin Oncol 19(7):2049–2056PubMed

21.

Pugh EM (1996) An investigation of general practitioner referrals to palliative care services. Palliat Med 10(3):251–257PubMed

22.

Ruhnke GW, Wilson SR, Akamatsu T et al (2000) Ethical decision making and patient autonomy: a comparison of physicians and patients in Japan and the United States. Chest 118(4):1172–1182PubMedCrossRef

23.

Sanders BS, Burkett TL, Dickinson GE, Tournier RE (2004) Hospice referral decisions: the role of physicians. Am J Hospice Palliat Care 21(3):196–202CrossRef

24.

Sanjo M, Miyashita M, Morita M, Kirai K, Akechi T, Uchitomi Y (2007) Preferences regarding end-of-life care and their association with concepts of good death: a population-based survey in Japan. Ann Oncol (in press)

25.

Schockett ER, Teno JM, Miller SC, Stuart B (2005) Late referral to hospice and bereaved family member perception of quality of end-of-life care. J Pain Symptom Manage 30(5):400–407PubMedCrossRef

26.

Shiozaki M, Morita T, Hirai K, Sakaguchi Y, Tsuneto S, Shima Y (2005) Why are bereaved family members dissatisfied with specialised inpatient palliative care service? A nationwide qualitative study. Palliat Med 19(4):319–327PubMedCrossRef

27.

Voltz R, Akabayashi A, Reese C, Ohi G, Sass HM (1997) Organization and patients’ perception of palliative care: a crosscultural comparison. Palliat Med 11(5):351–357PubMedCrossRef

28.

Voogt E, van der Heide A, Rietjens JAC et al (2005) Attitudes of patients with incurable cancer toward medical treatment in the last phase of life. J Clin Oncol 23(9):2012–2019PubMedCrossRef

29.

Weggel JM (1999) Barriers to the physician decision to offer hospice as an option for terminal care. WMJ 98(3):49–53PubMed

30.

Yabroff KR, Mandelblatt JS, Ingham J (2004) The quality of medical care at the end-of-life in the USA: existing barriers and examples of process and outcome measures. Palliat Med 18(3):202–216PubMedCrossRef

Title: Barriers to referral to inpatient palliative care units in Japan: a qualitative survey with content analysis
Authors: Mitsunori Miyashita
Kei Hirai
Tatsuya Morita
Makiko Sanjo
Yosuke Uchitomi
Publication date: 01-03-2008
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 3/2008
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-007-0215-1

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